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Workshop Report Global Nutrition and Health Workshop Workshop Report Global Nutrition and Health Workshop 9 June 2017 BEIS Conference Centre, London, UK 1 This report summarises the outcomes of MRC’s Global Nutrition and Health workshop, held on the 9 June in London. It draws on the research presentations and subsequent discussions, the conclusions from break-out groups and open general discussions, as well as answers to a pre-workshop survey. Background As an outcome of the OSCHR strategic review of nutrition research, the MRC has identified three main pillars of activity to maintain strengths in nutrition research: building a UK research base, developing a global nutrition and health strategy, and engaging with the food industry. To refine activities in global nutrition and health research, the MRC held a scoping workshop and information event. Delegates were largely UK-based global nutrition researchers (Annex 3). The aims of the workshop were the following: 1. To help the MRC prioritise scientific areas in global nutrition research; 2. To provide an opportunity to discuss challenges and rewards of working in/with Low and Middle Income Countries (LMICs); 3. To inform the community about MRC’s strategy for Global Health Research and the activities of MRC Global Health Group; 4. To inform the community about funding opportunities in global health, especially under the Global Challenges Research Fund (GCRF); 5. To consult the delegates on their longer-term strategic vision for global nutrition research and how best to shape future funding opportunities to achieve such vision; 6. To launch the Confidence in Global Nutrition and Health Research funding call. 2 Priorities in Global Nutrition and Health Research Tackling global nutrition problems must be founded on an in-depth understanding of the links between nutrition and health, and of the factors that determine nutritional patterns. Such understanding must rely on a holistic approach to nutrition research, requiring strong interactions between disciplines such as health and medical sciences, food production and supply systems, and social sciences. Delegates started by highlighting the most pressing global nutrition problems, with respect to relevance and scale of health challenges. With this in mind, delegates identified the areas in global nutrition research that must be prioritised to tackle health problems in the short and medium terms and to inform strategies to create long-term impact in global nutrition. The most pressing nutrition-related health problems identified were: - Malnutrition and micronutrient deficiencies-related conditions: stunting, wasting, growth faltering, impaired cognitive and behavioural development, impact of childhood malnutrition in later life. - The rise of Non-Communicable Diseases (NCDs) in some LMICs. - The emerging problem of the double burden of overweight and micronutrient deficiencies that can co-exist in the same population and even the same individuals. In order to tackle such problems, delegates agreed that the following research areas must be prioritised: 1. Mechanistic understanding: Nutritional adequacy in health and disease must be informed by basic/mechanistic research on the interplay between nutrition, health and disease. This echoes some of the recommendations of the OSCHR review: research should aim to establish the links between diet, general health and diseases including infections, inflammation, NCDs, and respective co-morbidities. Detailed mechanistic insights are necessary to: (i) advance understanding of underlying causes and consequences of malnutrition; (ii) understand the effects of nutrition on general physical and mental health and cognition; (iii) establish causality between nutrition and disease susceptibility, progression and outcome; (iv) establish how nutrient uptake is affected by general health (e.g. gut health and function, iron uptake and anaemia, gut microbiome and early microbial colonisation, and pathogenic organisms in the gut), disease status (such as infections), and lifestyle (e.g. physical activity). However, unexpected observations and failed nutritional interventions (as exemplified in Dr Ann Prentice’s talk, Annex 2) have exposed the risks of extrapolating nutritional evidence generated in western populations to world-wide settings, without considering genetic and epigenetic make-up or life history of the populations and individuals concerned. These observations stress the need for research into the inheritable bases for individual and population responses to nutrition and reach through to molecular level understanding and mechanisms. Researchers suggested that studies in migrant populations (originally from LMICs that are currently living in high income countries) may pave the way for understanding the genetic and molecular bases for population-specific responses to nutrition. 3 2. Nutrition through the life course: Current nutritional guidelines are largely based on evidence generated in healthy adults and lack evidence for pregnant and lactating women, children, adolescents or the elderly. A life course perspective in global nutrition research must be undertaken to inform nutritional adequacy in health and disease at these key life stages. There is extensive evidence demonstrating the importance of the first 1000 days of life (from conception to the 2nd birthday) in determining health outcomes and resilience to disease throughout life. Further research in this area is needed, but delegates also agreed that the focus should be extended to encompass pre-conception maternal health up to early childhood. For example, research into strategies to prevent childhood malnutrition through promoting healthy food habits amongst women, and adequate baby feeding practices and behaviours. In addition to prevention and treatment of acute malnutrition, more research is needed into the reversibility of childhood malnutrition effects: early childhood is a particularly critical period as it may present a window of opportunity to mitigate some of the life-long consequences of childhood malnutrition, such as susceptibility to NCDs in later life. As the burden of infection falls, the ageing demographic is changing (in particular in middle income countries), calling for guidance on nutritional requirements for healthy ageing. Such guidance must consider forms of food provision that are compatible with old-age health issues such as tooth decay. 3. Understanding the determinants of nutrition and dietary patterns: Nutrition and dietary patterns are largely determined by socio-economic and cultural context. Understanding the determinants of nutrition requires highly integrative/multidisciplinary research, for example including the following areas: Food production, the supply chain, and linkages to human health: Short and long-term solutions to food availability problems rely on the production and supply of nutritious food (as informed by mechanistic understanding). Research must therefore focus on sustainable agriculture and farming practices (harmonized with ecosystems and prepared for climate change); on improving the understanding of environmental effects on human health through agriculture (e.g. effects of fertilizers and pesticides and health of livestock); and on the safety of food supply chains to assure food hygiene. Finally, delegates emphasised the need for more evidence on the effects of marketing, food policy and food tax on dietary patterns to address the rise in consumption of food with high caloric content and to promote consumption of nutritious food. Delegates agreed that the research community must engage with food companies (be they local or international) to tackle global nutrition problems in the long term. Cultural and socio-economic factors that determine dietary patterns: Although contextual factors are broad, complex and very heterogeneous across the world, delegates prioritised research into the effects of education, literacy and family dynamics on nutrition. Important areas of study include strategies to educate and empower women to make dietary choices for themselves and their children. Effects of epidemiological transitions on dietary patterns: Transitioning societies have seen a rise in NCDs and of the double burden of malnutrition and obesity, mainly as a consequence of urbanization, changes in lifestyle and physical activity (sedentary jobs), and increased availability of food with high caloric content and poor nutritional value. 4 Although such health problems are common world-wide, mechanistic research is needed to establish causes and disease aetiology in different populations. A possible approach is to focus on causes of within-country nutrition and health inequalities. Effects of conflicts, natural disasters, and forced migration on food availability and dietary patterns: Research into migrating populations has the potential to provide key insights into resilience and adaptation to dietary changes, as well as the net effects of environment on nutrient uptake. 4. Nutritional Interventions: More intervention studies are needed but, as highlighted earlier, these must be: (i) informed by mechanistic evidence specific to the populations and health status of the individuals concerned; (ii) based on an understanding of the broad socio-economic context; (iii) culturally acceptable; (iv) aligned with health systems to coordinate delivery of care (when appropriate). Only then will the outcomes of such intervention studies be able to inform in-country nutrition policies and guidance. The successes and failures of past and on-going nutritional
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